Chapter 16 Testing Testing Physical Examination Terms
Physical Examinations are performed to assess a patientscondition. Medical Records are important written documents. assessment = evaluation of a condition an examiner's evaluation of the disease or condition based on thepatient's subjective report of the symptoms and course of theillness or condition and the examiner's objective findings, includingdata obtained through laboratory tests, physical examination,medical history, and information reported by family members andother health care team members signalment = description of the animal example of a signalment: 12-yr-old, F/S DLH 2-yr-old Arabian colt 4-mo-old barrows Bell Work Monday, Feb 3 What do the following abbreviations stand for?
MM CRT HR RR PE History obtaining information useful in formulating a diagnosis andproviding medical care to thepatient. Signalment Chief complaint (what is wrong) Duration of complaint (how long) Past medical problems Medications (including OTC, Holistic herbs, Supplements) Diet Review of all organ systems (brief or extensive?) Vital Signs Vital signs are parameters taken from the animal to assess itshealth. Temperature (T) febrile versus afebrile pyrexia Hypothermia Where measured:Rectal vs ear canal vs other? Pulse (P) Weak (heart failure, low blood pressure, shock) Strong Bounding, Regular, Irregular Where measured: femoral artery most common Respiration (R) Fast (panting) Labored (increased effort to breathe-heart disease/ cant getenough oxygen) Abdominal (pleural effusion-lungs are impaired) How measured Vital Signs Heart Rate Blood Pressure Too high Too low
Rhythm- irregular Sounds whooshing, muffled, non existant Blood Pressure Too high/ Too low Unstable 150/95( / )Systolic/Diastolic Cardiovascular, renal, ocular pressure Vital Signs Mucous Membranes Capillary Refill Time Pink (bubble gum)
White pale Blue cyanotic Red- (bright red or brick red) Yellow - jaundiced Capillary Refill Time 1-2 seconds is normal 2 seconds (greater than 2 seconds) slow, dehydration, shock, poor perfusion Types of Examination Auscultation Palpation (NOT palpitation!)
the act of listening to body sounds Heart, gut sounds, lungs Palpation (NOT palpitation!) examination by feeling Limbs, abdomen Percussion examination by tapping the surface to determine densityof a body area For example, since the heart is not resonant and the adjacentlungs are, when the examiner's fingers strike the chest over theheart the sound waves will change in pitch. Shock Lack of adequate blood volume to perfuse the bodystissues.Results can be fatal as multiple organs fail. Symptoms: Mm = pale, white, gray Hr=very high (or very low) Rr=very high or very slow and labored Difficulty breathing Pulse is weak and very high Confusion, stupor, weak, depressed Examples Blunt trauma Penetrating trauma Poison/toxin
HBC, high rise syndrome Penetrating trauma Gunshot, knife, stick impalement Poison/toxin Hyperthermia/hypothermia Bloat Massive infection (septic shock) How shock is treated Shock is called hypovolemic shock decreased bloodvolume (blood and fluid /plasma) Heart is unable to pump blood to the tissues To correct hypovolemia you must replace the blood/fluid Medications to increase blood pressure Dopamine, epinephrine, norepinephrine Determine the order of triage for the following critical cases:
8 yr, M/N dog, HBC.Has a wound in back left leg.MM arepink and the dog is walking. 4 yr, M/N cat.Extremely weak and not walking.Hx ofstraining in the litter box the day prior and not passing urine. Gums are pink. 2 yr, F/S Golden Retriever.Playing in the backyard and cameinside with a swollen face.Difficulty breathing, gums are palepink.Dog is a little depressed but alert, HR is 120, RR ispanting 7 week old Chihuahua puppy.Hasnt eaten all day.Wobblywhen walking, T=99.9, mm=pale pink.No hx of vomiting ordiarrhea Instruments used in Physical Exam
Stethoscope Parts of stethoscope Diaphragm Bell earpieces Auscultating body sounds Heart Lungs Digestive system Borborgamus Ileus Otoscope Light and an ear speculum
Battery operated Allows visualization of theear canal Also allows visualization ofother areas Ophthalmoscope Used to look at the retina Laryngoscope View the pharynx Assists in lowering epiglottis
Access to trachea for intubation Speculum Ehances visualization of an opening Many kinds of specula
Ear speculum (cone) Mouth speculum Centrifuge Spins fluid samples (blood,urine, feces in solution) toseparate fluid fromheavier solid particles Should always be acounterweight to balance Microhematocrit Centrifuge
Small thin tubes of blood Separates red blood cells (heavier) from the plasma Hematocrit = Ratio of red blood cells in blood Normal would be >40% Also called PCV Refractometer Measure specific gravity of
(concentration of solutes) in body fluids such as urine. Soap: A way to organize Subjective Objective Assessment Plan Subjective Personal Opinion Open to interpretation
Definition of Subjective Personal Opinion Open to interpretation Not necessarily facts Something perceived by someone else (client) This section should capture your subjective evaluation of the animal, herd,or problem, the clients observations, the client can be asked directedquestions about any complaints current or reportedly resolved -- andask appropriate follow-up questions and document all responses. (e.g. BAR bright, alert, responsive; depressed; improving; getting worse,no change, etc.) Objective Definition of Objective Facts
Unbiased or uninfluenced by another person including yourself It is what it is This section is compiled from the physical exam and diagnostictest or procedures; it typically summarizes measurable data (e.g. rectal temperature, blood glucose, echocardiography, etc.) Assessment Evaluation Judgement
This section is an analysis of the subjective and objective data For this component, the veterinarian pulls together the subjective information gathered during the interview with the client and the objectivefindings of the physical exam (and, possibly, laboratory or other studyresults) and consolidates them into a short assessment. The assessment portion usually shows processes by which you arrived at aconclusion or diagnosisIncludes rule outs Is written very specific and concise Plan Detailed Decisive Action (or no action)
A plan would include anything that will be done as aconsequence of the assessment and could include: Laboratory tests, hospitalization, treatment, medications,follow up instructions to client, next appointment Some videos, PE https://www.youtube.com/watch?v=LF1bd-JYhyo
Animated dog exam https://www.youtube.com/watch?v=O6uUNmZiLZY(30 min long-cow) https://www.youtube.com/watch?v=gdx3DhmtadA Cow exam For fun (11 minvet student) https://www.youtube.com/watch?v=DTv7AByGKI4 Bell Work Monday, Feb 10 An example of a subjective component of a SOAPwould be: An example of an objective component of a SOAPwould be: The assessment portion would include: The plan would include: Tomorrow: Tuesday in the Lab
You might want to bring an old shirt to coverclothing There will be a short worksheet-You will need tohave a pen or pencil Be aware that you may need to assist a classmate ifthey unexpectedly get ill Be interested!Not grossed out!Yes, stuff smells,but you may never see the inside of a cow stomachagain! Bell Work Tuesday, Feb 18 What is a disease? What makes it a disease?
Name some animal diseases. Pathogenic Organism and Disease Terms
microorganism that produces disease A living organism of microscopic dimensions Not all microorganisms are pathogens The microorganism in the pictures is not a pathogen- does not produce a disease, in fact Pathogenic Organism and Disease Terms
deviation from normal infectious disease noninfectious disease contagious (communicable) disease iatrogenic disease idiopathic disease Kochs germ Theory (simplified)
Defines an infectious disease The infectious agent should be detectable in sick animals butnot healthy animals It should be possible to isolate and culture (grow) theorganism Organisms taken from the culture and introduced into ahealthy animal should cause the same disease The same organism should be isolated from the second animalas well Infectious Disease Caused by microorganisms that gain entry into theanimals body How does a microorganism gain entry? Transmission Bloodborne blood/ body fluids Airborne respiratory droplets Fecal-oral transmission eating, drinking, licking contaminatedfood, water, objects Vector-borne- bloodsucking arthropods (insects such asmosquitoes, ticks, mites) that carry the disease from one to another Direct contact Bell Work Wed Feb 19 True or False
A pathogen is a microorganism that produces disease. True Not all microorganisms are pathogens. True-example of microbes in rumen Transmission has to do with whether or not a disease isdisease. False-transmission has to do with how a microorganism gains entry According to Kochs Germ Theory (aka Kochs Postulates) ahealthy animal could become sick if a pathogen from a sickanimal were introduced into the healthy animal. Assignment: due Wed Feb 19
Find an example of each of the following: A bloodborne disease (keyword-secretions) Felv, FIV, FIP, Canine Herpesvirus (CHV), An airborne disease Kennel Cough, Feline Viral Rhinotracheitis A vector-borne disease Heartworm, WNV, (Hantavirus, plague-animals as vectors) A disease transmitted by the fecal- oral route Parvovirus, roundworms, Cryptosporidosis Direct contact- touch, bite, scratch Anthrax, coronavirus, mersa Bloodborne disease Example: Hepatitis B and C in humans FIV, FIP, FeLV
Definition:Disease-producing microorganisms transmitted by means of blood, tissue, and bodyfluids containing blood Blood borne transmission is also considered Direct (or Indirect Contact?)Could be Droplet? Transmission of Pathogens Potential exposure occurs through contact with blood, bloody saliva, vaginal secretions,semen, and other potentially infectious bodily fluids. Sources of Infection Pathogens can be transmitted through open cuts, blisters, sores, acne, body piercings,new tattoos, amniotic fluid, joint fluid, brain and spinal cord fluid, fluid from aroundthe heart, and body cavity fluid. Example:Hepatitis B and C in humans FIV, FIP, FeLV Contagious vs Noncontagious
Contagious diseases are spread animal to animal Contagious diseases are also called communicablediseases and are spread through direct or indirectcontact An inanimate object that is contaminated with acontagious disease is called a fomite Fomites are sources of infection for other animals Water and food bowls, kennels, clothing and shoes Not all infectious diseases are contagious Tetanus Infectious Diseases 4 classes of agents (an agent is something thatproduces an effect) Bacterium/Bacteria Virus/Viruses Fungus/Fungi Parasites 1. Bacteria Staphylococci- (cocci means round) round, clusters
Skin infections, wounds, food poisoning Streptococci-round, chains Strangles Bacilli rod shaped anthrax Spirochetes spiral Leptospirosis Endospore oval body inside, resistant clostridium Rickettsia rod shaped, small ehrlichia Examples of Infectious Bacterial Diseases
Rabbit Pasteurella (Snuffles) Tuleremia (vector-ticks,flies) Horse Tetanus Strangles Cat Enteritis Cystitis Swine Yersinia Cattle E Coli Mastitis Anthrax Canine Leptospirosis (Lepto) Ehrlichiosis (Tick Fever) BordatellaBronchiseptica (kennelcough) 2. Examples of Infectious Viruses
Cattle Bovine Viral Diarrhea(BVD) Cats Feline Panleukopenia Calicivirus Feline Leukemia Virus Feline ImmunodeficiencyVirus Rabies - most warm bloodedanimals Dogs Parvovirus Distemper Horses West Nile Virus Equine Encephalomyelitis Bacteria vs viruses Is a living cell Prokaryote cell No Nucleus
Made up of cytoplasm, DNA, ribosomes, flagella Virus Not a living cell!But are considered alive becausethe reproduce, grow, develop, adapt, use energysources from their environment Made up of genetic material/ nucleic acid (DNA orRNA) enclosed in a protein shell All sorts of shapes, but are extremely tiny/ cannotsee with a regular microscope What about Retroviruses (Feline Leukemia and FIV): https://www.youtube.com/watch?v=eS1GODinO8w Viruses insert their genetic material into a living cell
The cell becomes the virus host The virus DNA/RNA becomes a part of the cells DNA so that during cell division the virus is being replicatedand passed on Eventually the virus DNA takes over, completely changesthe host cell/ kills its host cell and continues to replicateand create lots more viruses Bacteria/Viruses Ribosomes: Present / Absent
Living attributes: Living organism - Opinionsdiffer on whetherviruses are a form of life or organicstructures that interact with living organisms. Numberof cells: Unicellular; one cell / No cells; not living Structures: DNA and RNA floating freely in cytoplasm. Has cell wall and cell membrane / DNA or RNAenclosed inside a coat of protein. Treatment: Antibiotics / Vaccines prevent the spread and antiviralmedicationshelp to slow reproductionbut can not stop it completely. Enzymes: Yes / Yes, in some Nucleus: No / No Virulence: Yes / Yes Infection: Localized / Systemic Benefits: Some bacteria are beneficial (e.g. certain bacteria are required in the gut) / Virusesare notbeneficial. However, a particular virus may be able to destroy brain tumors (see references).Virusescan beuseful in geneticengineering. Reproduction: Fission- a form of asexual reproduction /Invades a host cell and takes over the cell causingit to make copies of the viral DNA/RNA. Destroys the host cell releasing newviruses. Size:Larger (1000nm) / Smaller ( nm Cell wall:Peptidoglycan/Lipopolysaccharide / No cell wall.Protein coat present instead. Prions Are proteins Not alive They do not have DNA or RNA
They have an ability to reproduce Can cause inherited or transmissible diseases Prions Prion diseases are fatal and cause progressive,neurodegenerative problems literally, holes in the brain The brain resembles a sponge / diseases are called spongiform Examples of spongiform encephalopathies are. 1)Scrapie.in sheep and goats 2)BSE .Mad Cow Disease 3)Chronic Wasting Diseasewild deer and elk Transmitted by inherited disease, or ingested from tissue of infected animals (brain, spinal cord) 3. Examples of Infectious Fungi (mycoses)
Dermatophytes (Ringworm) Thrush (? Fungus caused by anaerobic bacteria andmositure) Coccidioidomycosis (Valley Fever) Blastomycosis (South East) Histoplasmosis Candida (yeast infection) 4. Examples of Infectious Parasites
Heartworm (Dirofilaria immitis) TrichinellaTrichinosis Hookworm (Ancylostoma), Whipworm (Trichurisvulpis), Roundworm (Toxocara) Giardia (protozoan) Coccidiosis (protozoan) Noninfectious Disease Classifications
Classifying diseases helps aid the veterinarianinobtaining a diagnosis Helps the diagnostic process Clinical signs and symptoms could be the result ofseveral different disorders Differential diagnosis-a list of possible causes of disease Rule Outs-ruling out possible causes of disease throughdiagnostic testing, observation, trial treatment NonInfectious Disease Classifications
Metabolic-disruption of normal chemical reactions Diabetes, hypothyroidism, hyperthyroidism, Cushings, Addisons Anomalies Congenital Birth Defects Cleft palate, deaf, retinal dysplasia,dwarfism Degenerative progressive, permanent, longterm deterioration DJD (osteoarthritis), Bovine Spongioform Encephalopathy (BSE) Trauma Traumatic reticuloperitonitis, high rise syndrome,sucking chest wound,diaphragmatic hernia, peritonitis, prolapsed uterus Toxins - ingestion, inhalation, contact Antifreeze, misapplication of flea and tick products, warfarin (rat poison), toads, OTC medications, illegal drugs, plants Immune Immune Mediated Hemolytic Anemia (IMHA),System Lupus Erythematosus (SLE) Pruritis and Atopy (itchiness and hairloss) [allergies] NonInfectious Disease Classifications
Iatrogenic- a condition that develops as a result of treatment Hyperadrenocorticism (Cushings)- can be caused by treatment for a severeallergy problem Surgery-excision of Thyroid glad to treat hyperthyroidism in catsparathyroidmay also be removed causing iatrogenic hypoparathyroidism. Idiopathic- no explanation for underlying cause of the disease Idiopathic seizures Idiopathic renal hematuria Neoplasm - benign or malignant tumor Nutrition Acute acidosis in ruminants, malnutrition, skeletal disease, hypoglycemia,obesity 3 SEIZURE CASES Seizure Case 1: A 3 month old male toy poodle.The dog is strictly a house dog and does not run free,In addition to the seizures, it has had intermittent diarrhea and is quite thin. Differential Diagnosis (DfDx): Developmental Disorder- brain malformation Hypoglycemia-could be secondary to poor diet, diarrhea, intestinal parasites Head Trauma- not likely with indoor dog Toxins-potential for ingesting medications or illegal drugs, chocolate Infectious causes of encephalitis- Distemper Idiopathic epilepsy-very unlikely due to age of dog Seizure Case 2: A 2 year old male golden retreiver.This dog is in excellent physical condition and has been eating well.This dog is free to roam the neighborhood and recently had one episode of vomiting and one episode where it was limping and stiff. DfDx: Idiopathic epilepsy-this is high on the list because of age and breed of dog at the onset of seizures. Head Trauma-the recent limping and stiffness raises this possibility Toxins- the list is long, but possibilities include insecticides, chocolate Liver Disease-definitely needs to be ruled out but dog has been doing well otherwise Infectious Encephalitis Seizure Case 3: A 14 year old female schnauzer.This dog had its first seizure and since that time has not been acting normal.There has been some weight loss and a poor appetitie, and the owners feel the dog can no longer see.The dog is strictly an indoor dog with no history of trauma. DfDx: Metabolic Disease-liver dx, hypogylcemia (insulinoma in the pancreas), Diabetes Neoplasia- the age of the dog, the blindness, lack of normalcy after the seizure make this a high likelihood Ideopathic epilepsy-very unlikely with the age of the animal Pathogenic Organism and Disease Terms
Disease terminology Transmission-how pathogens gain entry Morbidity versus Mortality Morbidity- diseased animals Mortality diseased animals that die Moribund near death Prevelance - amount/ number of diseased at a given time (withina population) Susceptibility lacking resistance Noscomial Infections Noscomial- hospital (clinic) acquired infection
NosocomialinfectionAn infection occurring in a patient in a hospital or otherhealthcare facility in whom it was not present or incubating at the time ofadmission; or the residual of an infection acquired during a previous admission.Includes infections acquired in the hospital but appearing after discharge, andalso such infections among the staff of the facility. (Synonym: hospital-acquiredinfection Hygiene, cleaning, disinfecting, antimicrobial, infection control, isolation Often resistant type, ex: MRSA, Highly contagious potential for fatality ex: Parvovirus, Distemper, respiratory viruses Prophylaxis Prophylaxis-prevention of disease and spread of disease
Environmental-ventilation, cleanliness of facilities, insects,cleanliness of objects (preventing fomites), bedding, pens Health/ Nutrition (healthy animals remain resistant to most diseases) Stress releases cortisol and epinephrine/lower immunity Overcrowding, feeding frenzy, climate, noise, rough handling Minimize exposure or susceptability to pathogens Vaccinations-increase animals immunity Pets vs Herd, value/costs, allergic reactions, fibrosarcoma Testing prior to obtaining Quarantine (incubation) Zoonosis Zoonosis-disease that can be transmitted betweenanimals and humans Hosts Vectors (carry) Sentinels (watch/ warn) Zoonoses Zoonosis-disease that can be transmitted between animalsand humans (under natural conditions) How?Exposure of human to the infection of the animal If an animal has a disease and a human could get it, the diseaseis said to be zoonotic Transmission may occur through Direct contact with the animal Through a vector such as fleas or ticks Through food contamination Most at risk: young or immune suppressed (sometimes old), alsooccupations that require working with diseased or possiblydiseased animalssuch as veterinarians, lab researchers, farmersand ranchers, slaughterhouses Examples Avian Flu Transmitted by direct contact with infectedbirds/poultry In birds symptoms are illness, decreased production,death In humans typical flu syptoms, can be severe enough tocause death At risk population Backyard flocks Poultry business Veterinarians Examples Visceral Larva Migrans (larva of roundworms)
Fecal-oral transmission In animals (dogs) worms caninvade the liver, the lungs, theuterusparasitic and rob the hostsfood In humans the larvae migratethrough body tissues-lungs, liver,eyes Dog, cat, racoon is host eggs pass through intestines,dogs ingest (cycle) Zoonosis occurs when larvaeare unknowingly consumedby humans Host A host is a person or other living animal that contributes food and lodging to an infectious agent. *Primary host/ definitive host- organism / parasite gains maturity *Secondary/intermediate host- organism/parasite is in a larval stage *Transport host/ Vector a carrier in which the organism remains alive but does not develop Example of a disease with an intermediate host: Neospora Caninum coccidian parasite that causes disease in cattle:Definitive host is dog/ coyote/ fox, intermediate host is cattle:Oocysts in feces from dogs, cattle graze, oocystfinish in cattle Vector /Carrier A vector is a carrier, especially the animal thattransfer an infective agent from one host to another Example:Heartworm Disease Vector is the mosquito Carries the infective agent from one dog to another dog The dog is a host to Heartworms because the Heartwormcompletes its growth cycle in the dog Carrier does not become infected-no sign/symptoms of infectiousdisease (the mosquito does not get Heartworm Disease) Zoonosis Rabies Ringworm Toxoplasmosis Cats are host
Oocysts (eggs) pass through intestines Oocysts are ingested-toxoplasma organisms can invadebrain, fetus (pregnant women) Infected cats infect other animals oocysts form cysts inmuscle tissue-if food animal, human can become infected Cats become infected by eating rats Zoonosis West Nile Virus BSE Anthrax Leptospirosis
Bartonella Henselae (bacteria (bacillus) that causes catscratch fever) Equine Encephalitis Brucellosis Tuberculosis Avian Influenza Etiology and Epidemiology
Epidemiology-study of relationships determining frequencyand distribution of diseases disease etiology, outbreak investigation, disease surveillance andscreening, biomonitoring, and comparisons of treatment effects suchas in clinical trials. Etiology-study of disease causes/origination The etiology of scurvy is a good example. With scurvy, sailors goingto sea often lacked fresh vegetables. Without knowing the precisecause, Captain James Cook suspected scurvy was caused by the lackof vegetables in the diet. Based on his suspicion, he forced his crewto eat sauerkraut, a cabbage preparation, every day, but he hadno idea, precisely, why it prevented scurvy. It was only about twocenturies later - in 1926 that it was discovered that it was the lackof vitamin C in a sailor's diet that was the base cause of scurvy. Testing Methods Endoscopy Centesis
visual examination of the interior of any cavityof the body by means of an endoscope Centesis surgical puncture to remove fluid for diagnosticpurposes or to remove fluid or gas Testing Methods Imaging techniques radiography computed tomography
magnetic resonance imaging fluoroscopy ultrasound